For individuals living with bronchiectasis, a chronic lung condition characterized by persistent mucus buildup and frequent infections, a significant treatment advancement has emerged. Since its FDA approval in 2025, brensocatib (Brinsupri) offers a novel approach by directly targeting the underlying inflammation that drives the disease, rather than simply managing its symptoms.
Understanding the Mechanism of Action
Bronchiectasis often involves an overactive immune response in the lungs. When bacteria enter the airways, the body dispatches neutrophils – infection-fighting cells – to eliminate the threat. However, in bronchiectasis, this response can become excessive, leading to the release of damaging enzymes called neutrophil serine proteases. These enzymes, while initially intended to fight infection, can progressively harm healthy lung tissue and worsen mucus production.
Brensocatib works by blocking an enzyme called DPP1, which is crucial for activating these damaging enzymes within developing neutrophils. By inhibiting DPP1, the drug reduces the amount of lung tissue damage caused by these cells, potentially leading to decreased inflammation, improved mucus clearance, and fewer flare-ups.
As Dr. Amit Mahajan of Inova Health System explains, “As a result, people are more functional, are feeling better, and are more active.”
Clinical Benefits and Long-Term Impact
Reducing the frequency of exacerbations – acute worsening of bronchiectasis symptoms – is a key benefit of brensocatib. Dr. Panagis Galiatsatos of Johns Hopkins School of Medicine notes that “You want to reduce these exacerbations because they are a burden to a patient… [Brensocatib] won’t fully reverse the bronchiectasis, but it’ll keep it from being symptomatic.”
By controlling inflammation, brensocatib can help preserve lung function over time, slowing the disease’s progression. While not a cure, it represents a substantial improvement in management strategies.
Dosage, Administration, and Potential Side Effects
Brensocatib is administered as a once-daily oral pill, available in 10 mg and 25 mg dosages. The medication can be taken with or without food at any time of day, though consistency in timing is recommended.
Common side effects include upper respiratory tract infections, headaches, skin rashes, high blood pressure, and potential gum or dental problems. Gastrointestinal issues like nausea may also occur, though long-term effects are still under investigation due to the drug’s relative newness. The 25 mg dose appears to be associated with a higher incidence of side effects compared to the 10 mg dose.
Less frequent but notable side effects include hair loss, abnormal liver function tests, and, in rare cases, skin cancer. Regular dental checkups every six months are advisable, as the drug may increase the risk of gum disease. Live attenuated vaccines are not recommended while on brensocatib.
Conclusion
Brensocatib represents a significant step forward in bronchiectasis treatment by targeting the underlying inflammatory processes. While not a cure, it offers the potential to reduce flare-ups, improve quality of life, and slow the progression of lung damage. Individuals with bronchiectasis should discuss this new option with their healthcare provider to determine if it’s an appropriate addition to their existing treatment plan.
